PEM Review 014 – MIGRAINE // POPS SCORE // SEPTIC ARTHRITIS // APPENDICITIS // FRACTURES

PEMgeek3Welcome all new UK paeds ST1 doctors starting out this week – and congrats on choosing the best speciality in medicine 😉

Plenty of PEM FOAMed for everyone in this Review – stay up to date with management of paediatric migraine, septic arthritis and intranasal pain relief, plus plenty more:

pops     1. Top of the POPS

Finally, a paediatric early warning score (article @ADC_BMJ) that’s actually designed for use in ED – the Paediatric Observation Priority Score (POPS) system has undergone a successful large scale trial (over 24000 patients). The majority of patients (16475) had a POPS score of 0; of these patients 4.8% were admitted to hospital, and only 11 children discharged with a score of 0 returned later to be admitted and needed further definitive management. A previous study (@EmergencyMedBMJ) also showed that POPS could accurately predict 85% of children who could be discharged from ED. Hopefully use of tools such as this will soon start to become much more widespread.

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migraine   2. MIGRAINE

Migraine is sometimes thought of as more of an ‘outpatient’ diagnosis, but having a strategy to deal with acute migraine attacks in the ED is important. After ruling out any acute neurological deficits(!) remember the fluids and anti-emetics… and try to stay away from the opioids. Summary courtesy of Dr Delphine Huang on @ALiEMteam

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3. SEPTIC ARTHRITIS

Toxic synovitis or septic arthritis? @pedemmorsels reminds us of the diagnostic challenge presented by a limping child with a fever – there is no single test that is going to tell you definitively that the child DOES or does NOT have septic arthritis. Kocher’s criteria can help, but have to be interpreted in the context of your individual patient. High clinical suspicion, even if bloods are reassuring, should still make you think of having an urgent discussion with ortho.

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intranasal   4. NOT TO BE SNIFFED AT

When it comes to pain relief, intranasal drugs are a really important part of the paediatric ED toolbox. New podcast PEMplaybook.org (@EMtogether) gives us a rundown of commonly used intranasal medications (and importantly touches on some basics of pharmacodynamics) to help you to choose the right drug, for the right patient, at the right dose and right time.

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appendixcoloredshrunk  5. APPENDICITIS, ET AL

Over at DFTB, @paed_ed has written a mini-series on abdo pain in children. Here is the second installment, focusing on surgical causes – which has some important reminders about how appendicitis might present atypically.

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6. SALTER-HARRIS FRACTURES

Another memorable illustration from @medcomic… I also like the mnemonic SALTER:

  • Type 1 Slip (separated or straight across)
  • Type 2 Above, or Away from the joint
  • Type 3 Lower
  • Type 4 Through Everything
  • Type 5 Rammed (crushed)

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